Routine testing for a specific 'lipoprotein' known as Lp(a) would be a cost saving way to significantly reduce the risk of cardiovascular disease and save lives according to an international taskforce led by Monash University.
Elevated levels of Lp(a) impacts an estimated one in five people worldwide and leads to an increased risk of cardiovascular disease, the number one cause of death globally. Despite this, levels of Lp(a) are not routinely measured in clinical practice and most people with elevated levels don't know they're at risk – something the researchers call a "public health blindspot."
The Lp(a) International Taskforce was established by the FH Europe Foundation. Published in Atherosclerosis, the study analysed data from over 10,000 adults in the UK. The results were striking: routine Lp(a) testing would have reclassified 20 per cent of participants as high-risk, leading to earlier intervention with blood pressure or cholesterol-lowering medications.
The research team designed a health economic model based on the population data which showed that testing could prevent 60 heart attacks, 13 strokes and 26 early deaths (per 10,000 people tested) and lead to 169 years of life gained and 217 years of living in good health in Australia.
In 2020–21, an estimated 9.5 per cent of total allocated expenditure in the Australian health system ($14.3 billion) was attributed to cardiovascular disease. The researchers also found Lp(a) testing would save approximately $85 in societal costs (healthcare plus productivity burden) per person in Australia.
Senior author, Health Economist, Head of the Health Economics and Policy Evaluation Research (HEPER) group at Monash's Centre for Medicine Use and Safety (CMUS) and core member of the Lp(a) International Taskforce, Professor Zanfina Ademi, said Lp(a) testing should be standard practice.
"Elevated Lp(a) is an inherited, lifelong, and independent risk factor for heart attacks, strokes, aortic stenosis, and premature cardiovascular events," Professor Ademi said.
"Despite the risks, high Lp(a) remains dangerously underdiagnosed, with global testing prevalence reported to be exceedingly low. This significant oversight urgently demands international attention, which is why the FH Europe Foundation brought together an international taskforce to make Lp(a) testing routine and ensure equitable management across global populations."
First author, Dr Jed Morton, also from Monash University, said Lp(a) testing in Australia should be routine, and from a young age if it's known to run in the family.
"There is solid evidence to show that Lp(a) can be a major risk factor for cardiovascular disease - the earlier people are tested, the better the chances are of intercepting the problem before it escalates. Now is the time to act," Dr Morton said.
Co-author Professor Florian Kronenberg from the Medical University of Innsbruck, Austria, who played a central role in the study, said the findings further substantiate why early Lp(a) detection is vital.
"Lp(a) testing to reclassify cardiovascular disease risk in the primary prevention population aged between 40 and 69 years would address a critical gap in cardiovascular disease prevention. However, testing at a markedly earlier age would make even more sense to avoid losing years of preventive measures," Professor Kronenberg said.
Chief Executive Officer of the FH Europe Foundation and one of the co-authors of the study, Magdalena Daccord, said the hope is to see this important work progress into clinical practice.
"Cardiovascular disease is a major global health concern and preventative measures such as Lp(a) testing is such a simple way to pinpoint those at higher risk and put interventions in place," Magdalena Daccord said. "We look forward to continuing to work with our international collaborators to drive change and improve health outcomes for individuals and their families around the globe."
Commissioned by the Lp(a) International Taskforce and hosted by the FH Europe Foundation (FHEF), this patient-driven research initiative was led by the Centre for Medicine Use and Safety at the Monash Institute of Pharmaceutical Sciences, in collaboration with global researchers and the Lp(a) International Taskforce. The study forms part of a broader multistakeholder effort to advance understanding and action on Lp(a).
